Provider Demographics
NPI:1326069501
Name:HENRIETTA OPTICAL, INC.
Entity Type:Organization
Organization Name:HENRIETTA OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:585-334-2870
Mailing Address - Street 1:2116 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4518
Mailing Address - Country:US
Mailing Address - Phone:585-334-2870
Mailing Address - Fax:
Practice Address - Street 1:2116 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4518
Practice Address - Country:US
Practice Address - Phone:585-334-2870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCOO2938-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0124370001Medicare ID - Type Unspecified